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AUTISM DISORDERS / PERVASIVE DEVELOPMENT DISORDERS

Triple – S will cover for payment the following services as medically necessary in the evaluation of a known or suspected ASD case:
·         Audiological Evaluation

·         Behavior Evaluation including psychiatric test

·         Electroencephalograms when seizure states are suspected

·         Speech and language evaluation by a speech pathologist

·         Lead screening

·         Medical evaluation including history and physical exam

·         Specific screening for Autism

·         Neuroimaging studies when the child is a candidate for surgical intervention such as surgery for epilepsy

·         Occupational therapy and/or physical therapy when sensory motor deficiencies or motor planning is present

·         Sensorial Integrated Treatment

·         Quantitative testing for amino acids to determine phenylketonuria

Triple – S will cover for payment these services when any of the following criteria is met:

·         Loss of language or social skills at any age

·         Absence of babbling by 12 months of age

·         Absence of gestures (pointing) by 12 months of age

·         Absence of pronouncing ONE word by 16 months of age

·         Absence of pronouncing TWO words in a phrase by 24 months of age

Triple-S will cover for payment behavioral treatment in cases of ASD when all of the following criteria are met:

·         Criteria for ASD according to “Diagnostic and Statistical Manual of Mental Health Disorders” Fifth Edition, Text Revision (DSM-V-TR).

·         Services are appropriate in type, frequency, extent, site and duration

·         Services are provided by a professional staff in the behavior area

·         When it is expected that the therapy produces a measurable improvement

Triple-S will cover for payment, genetic testing for the following situations:

·         Genetic testing for mutations in the FMR1gene when the Fragile-X syndrome is suspected in presence of dysmorphologic characteristics or mental retardation.

·          Genetic testing for mutations in the MECP2 gene when presence of Rett’s syndrome is suspected.

·         Pre-pregnancy genetic testing to determine presence of a carrier when there is positive family history of the Fragile-X syndrome or Rett’s syndrome in a relative of first or second line of consanguinity.

·         Prenatal tests to the fetus (amniocentesis or biopsy of the chorionic villus sampling (CVS) when any parent is a known carrier of the FMR1 or MECP2 genes.

As expressed in the Welfare, Integration and Development of Individuals with Autism Law (BIDA in Spanish), Law No. 220 – 2012, of September 4, 2012 *, cognitive rehabilitation is considered for payment under autism conditions.

Triple-S does not consider for payment:

·         Allergy tests

·         Antibodies tests for “Celiac Disease”

·         Peroxidase erythrocyte glutathione studies

·         Evoked potentials

·         Hair analysis

·         Heavy metals tests

·         Immunological or neurochemical tests

·         Intestinal permeability tests

·         Magnetoencephalography

·         Vitamin levels

·         Lactate and pyruvate tests

·         Tests of Chelation for mercury

·         Urinary tests for peptides

Triple-S does not consider for payment the following therapies:

·         Acupuncture

·         Art Therapy

·         Auditory interaction training

·         Alternate communication

·         Chelation Therapy

·         Craniosacral Therapy

·         Dietary and Nutritional Intervention

·         Feedback

·         Equestrian Therapy

·         Facilitated Communication

·         Hyperbaric Oxygen Therapy

·         Immunoglobulin

·         Music therapy

·         Recreational Therapy

·         Secretin Infusion

·         Vision Therapy

787-277-6653 787-474-6326